Postoperative fast atrial fibrillation is a serious perioperative cardiac arrhythmia and a marker of increased morbidity and stroke risk. We report here a successful management of fast atrial fibrillation following video-assisted thoracoscopic thymic surgery in a patient with coronary heart disease. A 67-year old woman presented with heart palpitation and atypical chest pain for 9 months. CT coronary angiography demonstrated a 50% coronary stenosis in the right coronary artery (RCA) with proximal tube wall plaques. Our observations indicate that preoperative assessment, intraoperative monitoring, and pharmacological therapy play important role in the anesthetic management of thymic surgery in patients with coronary heart disease. The authors present physiological and pathophysiological discussions for clinical management of atrial fibrillation following thoracic surgery.